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Latest & greatest articles for chronic kidney disease
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a decision model structure. Longer term outcomes for survivors were modelled by a Markov process consisting of health states of chronickidneydisease (CKD) with cardiovascular disease, end-stage renaldisease and death. A lifetime horizon was then used. Outcomes assessed in the review The outcomes assessed in the review were: the in-hospital (30-day) mortality in patients with no renal complications, contrast nephropathy, and contrast nephropathy requiring dialysis; the annual mortality for elderly (...) of radiocontrast-induced nephropathy. Am J Kidney Dis 2004;44:12-24. Maeder M, Klein M, Fehr T, et al. Contrast nephropathy: review focusing on prevention. J AM Coll Cardiol 2004;44:1763-71. Indexing Status Subject indexing assigned by NLM MeSH Aged; ChronicDisease; Contrast Media /adverse effects; Cost-Benefit Analysis; Hemofiltration /economics; Humans; KidneyDiseases /complications; Renal Insufficiency /chemically induced /prevention & control AccessionNumber 22006000789 Date bibliographic record
as “> 60 mL/min/1.73m 2 ”, rather than as a precise figure. C hronic kidneydisease (CKD) is a morbid condition that is common and may be preventable. In the general Australian community, there is evidence of at least one indicator of CKD (proteinuria or reduced kidney function) in about 16% of adults aged over 25 years. CKD progresses to end-stage kidney failure at a rate that requires about 1900 Australians each year to commence renal replacement treatment — either dialysis or transplantation (...) glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in RenalDisease Study Group. Ann Intern Med 1999; 130: 461-470. Akbari A. Detection of chronickidneydisease with laboratory reporting of estimated glomerular filtration rate and an educational program. Arch Intern Med 2004; 164: 1788-1792. National KidneyDisease Education Program. Information for health professionals. GFR calculator. Available at: (accessed Jun 2005). Joint Specialty Committee on Renal
including white, African American, diabetic, and nondiabetic individuals.Prospective follow-up (through January 1, 2003) of Atherosclerosis Risk in Communities (ARIC) study participants, including 3859 African American and 10,661 white adults aged 45 to 64 years without severe renal dysfunction at baseline in 1987-1989, sampled from 4 US communities.Incident chronickidneydisease progression, defined as hospitalization or death with kidneydisease or increase in serum creatinine level of 0.4 mg/dL (35 (...) Apolipoprotein E and progression of chronickidneydisease. Apolipoprotein E (APOE) genetic variation has been implicated in diabetic nephropathy with the epsilon2 allele increasing and the epsilon4 allele decreasing risk. APOE allelic associations with chronickidneydisease beyond diabetic nephropathy are unknown, with no studies reported in high-risk African American populations.To quantify the risk of chronickidneydisease progression associated with APOE in a population-based study
Cardiovascular mortality risk in chronickidneydisease: comparison of traditional and novel risk factors. Elderly persons with chronickidneydisease have substantial risk for cardiovascular mortality, but the relative importance of traditional and novel risk factors is unknown.To compare traditional and novel risk factors as predictors of cardiovascular mortality.A total of 5808 community-dwelling persons aged 65 years or older living in 4 communities in the United States participated (...) in the Cardiovascular Health Study cohort. Participants were initially recruited from 1989 to June 1990; an additional 687 black participants were recruited in 1992-1993. The average length of follow-up in this longitudinal study was 8.6 years.Cardiovascular mortality among those with and without chronickidneydisease. Chronickidneydisease was defined as an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m2.Among the participants, 1249 (22%) had chronickidneydisease at baseline
Blood-pressure control for renoprotection in patients with non-diabetic chronicrenaldisease (REIN-2): multicentre, randomised controlled trial. In chronic nephropathies, inhibition of angiotensin-converting enzyme (ACE) is renoprotective, but can further renoprotection be achieved by reduction of blood pressure to lower than usual targets? We aimed to assess the effect of intensified versus conventional blood-pressure control on progression to end-stage renal disease.We undertook (...) outcome measure was time to end-stage renaldisease over 36 months' follow-up, and analysis was by intention to treat.Of 338 patients who were randomised, three (two assigned intensified and one allocated conventional blood-pressure control) never took study drugs and they were excluded. Over a median follow-up of 19 months (IQR 12-35), 38/167 (23%) patients assigned to intensified blood-pressure control and 34/168 (20%) allocated conventional control progressed to end-stage renaldisease (hazard
2005LancetControlled trial quality: predicted high
Chronickidneydisease: the global challenge. The worldwide rise in the number of patients with chronickidneydisease (CKD) and consequent end-stage renal failure necessitating renal replacement therapy is threatening to reach epidemic proportions over the next decade, and only a small number of countries have robust economies able to meet the challenges posed. A change in global approach to CKD from treatment of end-stage renaldisease (ESRD) to much more aggressive primary and secondary (...) prevention is therefore imperative. In this Seminar, we examine the epidemiology of CKD worldwide, with emphasis on early detection and prevention, and the feasibility of methods for detection and primary prevention of CKD. We also review the risk factors and markers of progressive CKD. We explore current understanding of the mechanisms underlying renal scarring leading to ESRD to inform on current and future interventions as well as evidence relating to interventions to slow the progression of CKD
Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronickidneydisease. The National Kidney Foundation has advocated the use of the abbreviated Modification of Diet in RenalDisease (MDRD) equation to estimate glomerular filtration rate (GFR) from serum creatinine measurements in clinical laboratories. However, healthy persons were not included in the development of the MDRD equation.To assess the accuracy of the MDRD equation in patients (...) with chronickidneydisease compared with healthy persons and to develop a new equation that uses both patients with chronickidneydisease and healthy persons.Cross-sectional study.The Mayo Clinic, a tertiary-care medical center.Consecutive patients (n = 320) who had an iothalamate clearance test specifically for chronickidneydisease evaluation and consecutive healthy persons (n = 580) who had an iothalamate clearance test specifically for kidney donor evaluation.Serum creatinine levels, GFR
Chronickidneydisease and the risks of death, cardiovascular events, and hospitalization. End-stage renaldisease substantially increases the risks of death, cardiovascular disease, and use of specialized health care, but the effects of less severe kidney dysfunction on these outcomes are less well defined.We estimated the longitudinal glomerular filtration rate (GFR) among 1,120,295 adults within a large, integrated system of health care delivery in whom serum creatinine had been measured (...) , community-based population. These findings highlight the clinical and public health importance of chronicrenal insufficiency.Copyright 2004 Massachusetts Medical Society
estimated rather than measured glomerular filtration rate.During the period examined, growth in incident ESRD outpaced growth in prevalent chronicrenal insufficiency, demonstrating that the ESRD epidemic in the United States is not merely a function of more cases of kidneydisease. Future research should examine other potential contributors to ESRD growth, such as improved survival from nonrenal diseases and more liberal entry into treatment programs. (...) The incidence of end-stage renaldisease is increasing faster than the prevalence of chronicrenal insufficiency. The steady increase in end-stage renaldisease (ESRD) incidence is a worldwide public health crisis.To determine whether the increasing incidence of ESRD in the United States is preceded by increased prevalence of chronicrenal insufficiency.Birth cohort analysis.Nationally representative Second and Third National Health and Nutrition Examination Surveys (NHANES II [1976-1980
The metabolic syndrome and chronickidneydisease in U.S. adults. The metabolic syndrome is a common risk factor for cardiovascular disease.To examine the association between the metabolic syndrome and risk for chronickidneydisease and microalbuminuria.Cross-sectional study.The Third National Health and Nutrition Examination Survey.Participants 20 years of age or older were studied in the chronickidneydisease (n = 6217) and microalbuminuria (n = 6125) analyses.The metabolic syndrome (...) with the metabolic syndrome compared with participants without the metabolic syndrome were 2.60 (95% CI, 1.68 to 4.03) and 1.89 (CI, 1.34 to 2.67), respectively. Compared with participants with 0 or 1 component of the metabolic syndrome, participants with 2, 3, 4, and 5 components of chronickidneydisease had multivariate-adjusted odds ratios of 2.21 (CI, 1.16 to 4.24), 3.38 (CI, 1.48 to 7.69), 4.23 (CI, 2.06 to 8.63), and 5.85 (CI, 3.11 to 11.0), respectively. The corresponding multivariate-adjusted odds
The prevalence of nontraditional risk factors for coronary heart disease in patients with chronickidneydisease. Risk for coronary heart disease is high among patients with chronickidney disease.To compare the prevalence of low apolipoprotein A1 levels and elevated apolipoprotein B, plasma fibrinogen, lipoprotein(a), homocysteine, and C-reactive protein levels by estimated glomerular filtration rate (GFR).Cross-sectional study.Third National Health and Nutrition Examination survey.12 547 (...) , 3180, and 744 persons with estimated GFRs of at least 90, 60 to 89, or less than 60 mL/min per 1.73 m2, respectively, who were at least 18 years of age.Chronic kidneydisease was defined as an estimated GFR of less than 60 mL/min per 1.73 m2 based on the abbreviated Modification of Diet in RenalDisease formula.After standardization for age, race or ethnicity, and sex, lower estimated GFR (> or =90, 60 to 89, or <60 mL/min per 1.73 m2) was associated with lower average levels of apolipoprotein A1
A, Sarnak M J CRD summary This systematic review concluded that N-acetylcysteine is effective in the prevention of renal contrast nephropathy in patients with pre-existing chronickidneydisease. Although there were some limitations of the review in terms of measures taken to minimise reviewer bias and possible statistical diversity, overall, the authors' conclusions appear reliable. Authors' objectives To assess the effects of N-acetylcysteine (NAC) in the prevention of renal contrast nephropathy (RCN (...) Prevention of radiocontrast nephropathy with N-acetylcysteine in patients with chronickidneydisease: a meta-analysis of randomized, controlled trials Prevention of radiocontrast nephropathy with N-acetylcysteine in patients with chronickidneydisease: a meta-analysis of randomized, controlled trials Prevention of radiocontrast nephropathy with N-acetylcysteine in patients with chronickidneydisease: a meta-analysis of randomized, controlled trials Alonso A, Lau J, Jaber B L, Weintraub
National Kidney Foundation practice guidelines for chronickidneydisease: evaluation, classification, and stratification. Chronickidneydisease is a worldwide public health problem with an increasing incidence and prevalence, poor outcomes, and high cost. Outcomes of chronickidneydisease include not only kidney failure but also complications of decreased kidney function and cardiovascular disease. Current evidence suggests that some of these adverse outcomes can be prevented or delayed (...) by early detection and treatment. Unfortunately, chronickidneydisease is underdiagnosed and undertreated, in part as a result of lack of agreement on a definition and classification of its stages of progression. Recent clinical practice guidelines by the National Kidney Foundation 1) define chronickidneydisease and classify its stages, regardless of underlying cause, 2) evaluate laboratory measurements for the clinical assessment of kidneydisease, 3) associate the level of kidney function
Environmental lead exposure and progression of chronicrenaldiseases in patients without diabetes. Previous research suggests that environmental lead exposure correlates with age-related decreases in renal function.Two hundred two patients with chronicrenal insufficiency (indicated by a serum creatinine level between 1.5 mg per deciliter and 3.9 mg per deciliter) who had a normal total-body lead burden and no history of exposure to lead were observed for 24 months. After the observation (...) than that in the controls during the 24-month period of repeated chelation therapy or placebo.Low-level environmental lead exposure may accelerate progressive renal insufficiency in patients without diabetes who have chronicrenaldisease. Repeated chelation therapy may improve renal function and slow the progression of renal insufficiency.Copyright 2003 Massachusetts Medical Society
The timing of specialist evaluation in chronickidneydisease and mortality. Care for chronicrenal failure involves management of complications and preparation for possible dialysis. Patients often are not evaluated by nephrologists in a timely manner.To identify factors associated with late evaluation by a nephrologist and to assess whether late evaluation is associated with worse survival once patients develop end-stage renaldisease (ESRD).National prospective cohort study.81 dialysis (...) characteristics, and socioeconomic status in Cox proportional hazards regression analysis. After additional adjustment for such factors as the presence and severity of comorbid conditions, the association remained graded (hazard ratio, 1.2 [CI, 0.73 to 1.82] for patients evaluated at an intermediate point and 1.6 [CI, 1.04 to 2.39] for those evaluated late).Late evaluation of patients with chronicrenal failure by a nephrologist is associated with greater burden and severity of comorbid disease, black
Chronicrenaldiseases: renoprotective benefits of renin-angiotensin system inhibition. Progression to renal parenchymal damage and end-stage renaldisease, which seems to be largely independent of the initial insult, is the final common pathway for chronic, proteinuric nephropathies in animals and humans. The key event is enhanced glomerular capillary pressure; this impairs glomerular permeability to proteins and permits excessive amounts of proteins to reach the lumen of the proximal tubule (...) . Clinical data strongly suggest that remission can now be achieved in some patients with chronicrenaldisease. Because of the current lag time between starting treatment and remission, however, a substantial proportion of patients still progress to end-stage renaldisease before renal function begins to stabilize. A multimodal approach that centers on reducing or removing all risk factors associated with the progression of renaldisease may decrease the time to remission of the disease for most
Low protein diets delay end-stage renaldisease in non diabetic adults with chronicrenal failure. Since more than fifty years, low protein diets are proposed to patients with kidney failure. However, the effects of these diets in preventing severe renal failure and the need for maintenance dialysis is still controversial.To determine the efficacy of low protein diets in delaying the need to start maintenance dialysis.Medline and Embase search from January 1966 through June 1999. Congress (...) a reduced protein intake and 741 a larger protein intake. Collection of the number of "renal death" being the need for starting dialysis, the death of a patient or the transplantation of a kidney during the trials.242 renal deaths were recorded, 101 in the low protein diet and 141 in the larger protein diet group, giving an odds ratio of low protein to control of 0.62 with a 95% confidence interval of 0.46 to 0.83 (p<0.001, Peto odds ratio). To spare one extra renal death, 17 patients need to be treated
Diuretics acting on the distal renal tubule for preterm infants with (or developing) chronic lung disease. The aim of this review is to assess the risks and benefits of diuretics acting on distal segments of the renal tubule (distal diuretics) in preterm infants with or developing chronic lung disease (CLD). Primary objectives are to assess changes in need for oxygen or ventilatory support and effects on long-term outcome, and secondary objectives are to assess changes in pulmonary mechanics (...) and potential complications of therapy.We used the standard method of the Cochrane Neonatal Review Group. We used the following keywords: ¿ or <chronic lung disease>¿ and , limited to and limited to or . We searched Medline (1966-1998), Embase (1974-1998) and the Cochrane Controlled Trials Register (CCTR) from the Cochrane Library (1999, issue 2). In addition, we hand searched several abstract books of national
across a spectrum of disease causes and renal dysfunction. Research: The authors do not report any research implications of the review. Funding Division of Nephrology and Hypertension, University of North Carolina. Bibliographic details Kshirsagar A V, Joy M S, Hogan S L, Falk R J, Colindres R E. Effect of ACE inhibitors in diabetic and nondiabetic chronicrenaldisease: a systematic overview of randomized placebo-controlled trials. American Journal of KidneyDiseases 2000; 35(4): 695-707 PubMedID (...) Effect of ACE inhibitors in diabetic and nondiabetic chronicrenaldisease: a systematic overview of randomized placebo-controlled trials Effect of ACE inhibitors in diabetic and nondiabetic chronicrenaldisease: a systematic overview of randomized placebo-controlled trials Effect of ACE inhibitors in diabetic and nondiabetic chronicrenaldisease: a systematic overview of randomized placebo-controlled trials Kshirsagar A V, Joy M S, Hogan S L, Falk R J, Colindres R E Authors' objectives
Cross sectional longitudinal study of spot morning urine protein:creatinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronicrenaldisease in patients without diabetes. To evaluate whether the protein:creatinine ratio in spot morning urine samples is a reliable indicator of 24 hour urinary protein excretion and predicts the rate of decline of glomerular filtration rate and progression to end stage renal failure in non-diabetic (...) patients with chronic nephropathy.Cross sectional correlation between the ratio and urinary protein excretion rate. Univariate and multivariate analysis of baseline predictors, including the ratio and 24 hour urinary protein, of decline in glomerular filtration rate and end stage renal failure in the long term.Research centre in Italy.177 non-diabetic outpatients with chronicrenaldisease screened for participation in the ramipril efficacy in nephropathy study.Rate of decline in filtration rate